Microdiscectomy - One Month on

One month after surgery for a herniated L5-S1 disc, here are some FAQs answered, and a digest of my experiences for the benefit of anyone considering such surgery.

Firstly a caveat. These are my experiences of surgery to my L5-S1 disc and my observations relate solely to my experience. Your experience may differ.

How long will I be in hospital?

You can be out of hospital the same day. I was the first person operated on that day and was on my way home less than 12 hours after entering the operating theatre. However, if your operation is later in the day or your reaction to the anaesthetic is less problem free you may well find you spend one or maybe two nights in hospital.

You should plan to spend at least one night in hospital

How long will I be off work?

I was advised 4-6 weeks before my operation. 

You are well enough to answer emails etc within a couple of day or two of the operation. So if keeping in touch with the office is critical then you can do it. The problem is that sitting for long periods will cause you discomfort. Bad discomfort for the first couple of weeks, getting better progressively. Let's face it, if you are putting yourself through this surgery you need to put yourself first for a while. 

After 4 weeks I felt ready to work, but my back was still not deemed strong enough by the doctor and a further two weeks off work were certificated.

After that 2 week period a phased return is in the offing with a combination of home working and limited travel to work. Gradually getting back to normal patterns of work.

You should definitely plan for a 4 week physical absence from work. Any work you can do remotely should not involved prolonged sitting, and you should take advice re: home office ergonomics.

How long before I am back to normal?

One of the aims of the op was to relieve my sciatica symptoms. It could take up to 6 months to see if this is a success.

My back pain is gone. I can bend without the pain I had before the op. But the strength isn't there. It could be 6 months before I am able to lift any significant weight.

I should be fit to umpire a cricket match after 12 weeks, and fit to resume playing more active sports after 24 weeks (6 months).

Don't expect to be fully recovered (or as recovered as you will be) until 6 months have passed.

What is the operation like?
You are under a general anaesthetic so you won't know anything about it. The operation takes anywhere from 1 to 2 hours. Because you are on your front for the duration of the operation you will have red marks on the front of your body and your face. These will fade. I was taken to the theatre just before 9am, was awake in recovery by around 11.30 and back on the ward by midday.

How will I feel directly after the operation?
You are clearly still full of drugs. I was told I could have various painkillers right up to liquid morphine if I needed it. I didn't. I was stiff and achy, as if I had freshly injured my back (which in a way I had), but apart from some soreness I was not in too much discomfort.

A couple of hours after the op I was able to walk to the toilet to urinate. Upon my return I was able to dress myself.

Depending on when you have your operation and how well you respond to the anaesthetic determines when you will be released from hospital. I was fortunate enough to have been first in theatre that day and was released in the evening.

The 1 hour drive home was not too uncomfortable. Make sure you have soft pillows available to support your back on the journey home.

Plan your journey home with comfort in mind.

What medication will I take?

You may be prescribed a painkiller such tramadol, and make sure you have a supply of ibuprofen at home. The ibuprofen will help to reduce inflammation as well as ease pain. Gabrapentin may also be prescribed if you have neuropathic pain such as sciatic symptoms. I was given two gabrapentin tablets to take the day after the operation and was advised by my doctor that I could have more if I felt serious sciatic pain as my sciatic nerve came back to life.

For a while I took a tramadol and a diazepam tablet each night in order to give me a good start to my night's sleep.

What pain will I be in?
Discomfort and soreness characterise the pain you feel in the first week. If you sit for too long you get sore and stiff. If you walk too much you are sore and ache. There is no getting away from the soreness. But it is manageable with ibuprofen and tramadol.

In the second week I developed more localised pain in my left side. This is the side that the disc was bulging. It may have been a side effect of the exercises I was doing, or a natural reaction to increased activity in general. Within a week this pain had passed.

It is likely that within 2-3 weeks of the operation, any pain you are in will be significantly less and more sporadic than the pain you had before the operation.

After about 10 days, around the same time my mobility real increased. I developed pain and spasms when turning in bed. In order to ensure at least a partially good night's sleep I took tramadol  for the pain and diazepam to relax my muscles. These spasms lasted for 10-14 days but gradually became less frequent.

After 4 weeks you will feel very good in yourself and pain will come and go depending on how well you look after yourself.


Listen to your body and manage your pain



What will my wound be like?
The wound is around 2 inches in length. Neatly sewn with dissolvable stitches. At first look you wonder what kind of scar you will be left with . The sewn up incision is significantly raised. The wound is tender at first but never excessively so.

From 48 hours after the operation significant bruising emerged. It looked blotchy and red. Due to concerns about infection in the wound area I had it checked by a doctor, but it was just natural bruising in reaction to the operation and sitting still.

The dressing on the wound must stay on for 48 hours after the operation. After that there is no increased risk of infection from showering (though a bath is not possible). You are not supposed to soak the wound due to the stitches. I used the antimicrobial wash that I had to bath with pre op. Spread it over the wound and then by the time I had washed my hair I was ready to rinse the wound site and then immediately dry (patting with a towel rather than rubbing).

Scabs will form on the wound. It might itch occasionally, but resist the urge to scratch. Serious itching may be due to infection so keep an eye on the wound (I took photos each day to check if the wound checked in appearance).

In just over 3 weeks the wound was clear of scabs, smooth and well healed.

Look after your wound, keep it clean and if you are concerned about an infection get it checked asap.

Are there any unexpected side effects?
What they don't tell you is that a common side effect of this surgery is that you often get constipated. That's not usually such a big deal, but when your lower back has been sliced open, it is not much fun trying to persuade your body to expel several days of waste.

Try to avoid getting a cold. You don't want to sneeze. For at least 3 weeks this would be very painful. 

When will I be able to drive?

There are several things you need to be able to do consistently and without causing pain before you can drive:

Twist - This is especially the case if you need to reverse.

Emergency Stop - you need to be able to stamp your foot hard onto the brake.

Sit for periods of 30 mins plus - I tried a short drive 12 days after my operation and it left me sore. 4 weeks after the operation I have driven for 40 minutes with no ill effects.

Operate the pedals without discomfort - for obvious reasons.

It may be 3 weeks before you can cope with a drive of 30mins plus with negligible side effects.

What exercises will help?

You should try to be active from your first day at home. Certainly, sitting around all day does nothing to benefit your back. Don't sit for too long. Set an alarm to prompt you to get up regularly. Initially sit for 30 mins and get up for 5. Build to 60 mins with a 10-15 minute period of activity. I filled that time with a rudimentary step routine on my stairs. 50 steps.

A set of light exercises provided by the Oxford Radcliffe Hospitals are designed to gently stretch you and maintain flexibility were part of my programme. It said to so them 3 times a day but I didn't get to that level until into my 2nd week. Take advice prior to starting any stretching exercises.

Later I walked with a book balanced on my head to encourage the right posture. There is no sense healing your back into a slouch.

A couple of days after the op I was able to walk 1 mile. It was very tiring but great for my morale. Gradually the walks got longer and the tiredness diminished. The walking became more fluid. The trick is to keep walking regularly.

Walking on uneven surfaces is more of a challenge. After a couple of weeks of very little exercise, your muscles will have weakened, particularly those muscles that give you stability on uneven ground.

My physiotherapist gave me a new set of exercises at the 4 week point.

I will be starting to swim, and my physio recommends backstroke or front crawl. Breast stroke and butterfly are not advised.

Take advice from your surgeon and doctor before the operation to ensure you have an appropriate recovery exercise programme. I wish I had had one from the start. 


Nourish your soul
You will have a lot of time to think. Fill your time productively. Have people visit you and take you out from time to time. Read, enrich yourself by what you watch on tv. Interact with people. You will have a lot of time to yourself. Don't waste it. Construct a plan and get things in place before you have the operation.



Final thoughts
Is this something to be worried about? All surgery has its risks so it would be stupid to say no. But in the hands of a good neurosurgeon this is a routine operation. The results are not entirely predictable however. But if a herniated disc is making your life a misery, or stopping you from being as active as you would like I would recommend it. It is worth the level of discomfort I have had in order to see if it works.